Abstract
Objective
This study aimed at identifying the gaps, barriers and successes/solutions associated with mental health services in Mi’kmaq communities in Nova Scotia.
Methods
Community-based participatory research, which is consistent with Ownership, Control, Access and Possession principles of research with Aboriginal communities, was employed for this work. Health directors of the 13 Mi’kmaq communities in Nova Scotia were involved with the research question, design and write-up of the study. This qualitative descriptive study consisted of open-ended structured interviews with consumers, family members and health care providers. Systematic data collection and analysis of interviews present an understanding of issues of mental health services in the communities.
Results
The findings identified barriers and successes/solutions in mental health services in First Nations communities, where services and resources are different from those in more urban communities. Core programs, covering aspects of education, collaboration and culturally relevant community-based services, were identified as solutions to problems identified by participants. Service providers specified core funding for services as essential for continuity and sustainability.
Discussion
While efforts have been made in the past to address mental illness in Mi’kmaq communities, many of these efforts have been proposal driven or crisis oriented. The need for community-based, culturally appropriate, coordinated and sustainable services is evident on the basis of the study’s findings. The final report has been disseminated to local community members, participants, Atlantic First Nations and Inuit Health Branch, the Provincial Department of Health and the Atlantic Policy Congress to provide evidence that can inform policy and practice related to mental health in Mi’kmaq communities in Nova Scotia.
Key words: First Nations, mental health, community-based participatory research, OCAP principles
Résumé
Objectif
Repérer les lacunes, les obstacles et les réussites/solutions associés aux services de santé mentale dans les communautés Mi’kmaq de la Nouvelle-Écosse.
Méthode
Nous avons employé la recherche participative communautaire, car elle respecte les principes d’appropriation, de contrôle, d’accès et de possession (ACAP) de la recherche auprès des communautés autochtones. Les directeurs des services de santé des 13 communautés Mi’kmaq de la Nouvelle-Écosse ont participé à l’élaboration des questions de recherche, à la conception et à la rédaction de l’étude. Qualitative et descriptive, cette étude comportait des entrevues dirigées avec des questions ouvertes menées auprès d’usagers, de membres de leur famille et du personnel soignant. La collecte et l’analyse systématiques des données d’entrevues a permis de comprendre les enjeux des services de santé mentale dans ces communautés.
Résultats
Nous avons relevé à la fois des obstacles et des réussites/solutions dans les services de santé mentale des communautés des Premières nations; dans ces communautés, les services et les ressources sont différents de ce que l’on trouve en milieu urbain. Les problèmes signalés par les participants semblent pouvoir être résolus par des programmes de base couvrant à la fois l’instruction, la collaboration et les services communautaires adaptés aux différences culturelles. Et selon les fournisseurs de services, le financement de base est essentiel à la continuité et à la viabilité des services.
Discussion
Ce n’est pas la première fois que l’on s’attaque à la maladie mentale dans les communautés Mi’kmaq, mais bon nombre des efforts passés ont découlé de propositions de projets ou ont été déployés en situation de crise. Notre étude montre qu’il existe clairement un besoin de services communautaires adaptés aux différences culturelles, coordonnés et durables. Le rapport final a été diffusé aux résidents locaux, aux participants, à la Direction générale de la santé des Premières nations et des Inuits–Région de l’Atlantique, au ministère provincial de la Santé et à l’Atlantic Policy Congress [of First Nations Chiefs]; les données probantes qu’on y trouve peuvent éclairer les politiques et les pratiques en santé mentale dans les communautés Mi’kmaq de la Nouvelle-Écosse.
Mots clés: Premières nations, santé mentale, recherche participative communautaire, principes ACAP
Footnotes
Acknowledgements: The authors acknowledge the following for their contributions, without which the study would not have been possible: Julian Julien, Health Director, Afton; Christine Potter, Health Director, Bear River; Terry Knockwood, Health Director, Indian Brook; Elaine Allison, Health Director, Wagmatcook; Christine Potter, Health Director, Bear River; Elizabeth Paul, Health Director, Mill Brook; Darlene Paul, Health Director, Memebertou; Laurie Touesnard, Health Director, Chapel Island; Sally Johnson, Union of Nova Scotia Indians; Tryna Booth, Policy Analyst, Atlantic Region First Nations Indian and Inuit Health Board; Josephine Muxlow, CNS Mental Health, Atlantic Region, First Nations Indian and Inuit Health Board; and Lindsay Marshall (Research Assistant), nursing graduate, Dalhousie University. For funding of this study thanks go to the Atlantic Aboriginal Health Research Program, funded by the Canadian Institutes of Health Research, Institute of Aboriginal People’s Health.
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